Impact on Women

While it is important for men's own health that they become more involved in HIV prevention and care, there are important benefits for women too. Some of these link to women's heightened vulnerability to HIV infection, others tie more closely to equality and equity in care.

Women's vulnerability to HIV transmission is partly a matter of biology. Because vaginal tissue is fragile, particularly in younger women, during unprotected vaginal intercourse an HIV-positive man is twice as likely to transmit the virus to an uninfected woman as an HIV-positive woman is to infect her male partner.

For the female partner, an even riskier alternative to vaginal intercourse is unprotected anal intercourse. Studies from Africa, Asia and North America have shown up to 19% of women reporting anal intercourse at least once in their lives, in some cases when there is a concern to "preserve" virginity or prevent pregnancy.

Women are also made vulnerable by men's greater economic and social power, and by unequal gender relations. It is men who generally decide when and with whom to have sex and whether to use condoms. This leaves women with little or no control over their exposure to the virus. It is men too who are most usually the perpetrators of sexual violence, whether in war or civil unrest, or within ongoing relationships.

In follow-up to the Beijing Fourth World Conference on Women, the 43^rd session of the UN Commission on the Status of Women (1999) drew attention to the need to educate women and men, particularly young people, with a view to promoting equal relationships between women and men, and to encouraging men to accept their responsibilities in matters relating to sexuality, reproduction and child-rearing.

While there have been some initiatives over the past two decades aimed at reducing women's vulnerability to HIV and empowering them to have greater control over their sexual and reproductive lives, both the scale of these efforts and their success have fallen far short of what is needed. That is why many advocates for women's health now argue that improving the status of women and helping them to protect themselves also requires greater co-operation from men. In other words, HIV prevention activities involving men hold the potential to benefit women as well.

This does not mean reducing the number or focus of programmes aimed at women. Everyone at risk of infection, whatever their gender, status or sexuality, has the right to protect themselves from HIV. However, programmes for women will be much more effective when they are accompanied by parallel efforts directed at men. It is the potential synergy between these two complementary sets of activities that needs greater emphasis.

How Many Partners? A 1995 World Health Organization study showed that in all of the eighteen countries surveyed men had more sexual partners than women. This behaviour appears to be true of every culture. A Costa Rican study showed that 99% of women in that country claimed to have had no more than five sexual partners in their lifetime, while 55% of men claimed six or more. In the United Kingdom, 24% of men claimed ten or more women partners in their lifetime, while only 7% of women claimed the same number of male partners. In any given year, the vast majority of women -- 90% or more -- report that they are either abstinent or faithful to one sex partner. Most men follow the same pattern, but the percentage is closer to 70%. Because men have on average more sex partners, and because male-to-female transmission is twice as efficient as female-to-male, men have more opportunity to both contract and pass on HIV, and on average can be expected to infect more partners over their lifetime.